Body Integrity Identity Disorder (Edmundson)

Some of us think that all value is in some sense subjective. Many others of us think that personal autonomy is an objective value (if any are) and that what we choose to do with ourselves is, morally speaking, up to us. Many of us also think that in some sense our bodies are ours to do with as we wish, so long as what we do with them doesn't harm or directly offend others. What then to make of people like Susan Smith, the pseudonymous author of "I won't be happy until I lose my legs" (The Guardian, 1/27)?

I was six when I first became aware of my desire to lose my legs. I
don't remember what started it - there was no specific trigger. Most
people want to change something about themselves, and the image I have
of myself has always been one without legs.

To the general public,
people like me are sick and strange, and that's where it ends. I think
it is a question of fearing the unknown. I have something called body
identity integrity disorder (BIID), where sufferers want to remove one
or more healthy limbs. Few people who haven't experienced it themselves can understand what I
am going through. It is not a sexual thing, it is certainly not a
fetish, and it is nothing to do with appearances. I simply cannot
relate to myself with two legs: it isn't the "me" I want to be. I have
long known that if I want to get on with my life I need to remove both
legs. I have been trapped in the wrong body all this time and over the
years I came to hate my physical self.

Not an easy case to know what to think about, nor to think about at all. But saying, "Well, Susan, if that's what you really want...," doesn't seem to be quite the right way to leave it.

[Upate: Carl Elliott (Philosophy and Bioethics, Minnesota) has written on BIID, also known as apotemnophilia, in "A New Way to Be Mad," Atlantic Monthly (Dec. 2000).]

[Further update: A must-read on BIID is Tim Bayne and Neil Levy's “Amputees By Choice: Body Integrity Identity Disorder and the
Ethics of Amputation”, Journal of Applied Philosophy, vol.
22, no. 1, pp. 75–86 (2005) available here (thanks to Iain Brassington for the pointer). Also, my colleague Eric Rovie is currently revising a paper on BIID: I am hoping to link a draft shortly.]